Perioperative Nursing Skills

Front 1

conscious sedation/analgesia

Back 1

type of anesthesia used for short procedures; the iv administration of sedatives and analgesics raises the pain threshold and produces an altered mood and some degree of amnesia, but the patient maintains cardiorespiratory function and can respond to verbal commands.

Front 2

embolus

Back 2

foreign body or air in the circulatory system

Front 3

thrombophlebitis

Back 3

inflammation in a vein associated w/ thrombus formation

Front 4

urgency of surgery

Back 4

elective
urgent
emergency

Front 5

degree of risk: surgery

Back 5

major or minor

Front 6

purpose of surgery

Back 6

diagnostic
ablative (removed diseased body part)
palliative
reconstructive
transplantation
construction

Front 7

Preoperative Patient Care: Hospitalized Patient

Back 7

Steps in nursing interventions for pre-op to follow. Will follow action-rationale format.

Front 8

1. Identify patients for whom surgery is a greater risk.

Back 8

(High risk: very young/elderly, obese or malnourished, fluid/electrolyte imbalance, patients in poor general health from chronic disease and infectious processes, patients taking meds and extremely anxious patients)

Rationale: ID of pts that are high risk can help prevent complications after surgery.

Front 9

2. Review the nursing databas, history, and physical examination. Check that the baseline data is recorded; report those that are abnormal.

Back 9

Rationale: Review identifies pts who are surgical risks.

Front 10

3. Check that diagnostic testing has been completed and results are available; id and report abnormal results.

Back 10

Rationale: This check may influence the type of surgery performed and anesthetic used, as well as timing of surgery or the need for additional consultation.

Front 11

4.Promote optimal nutrition and hydration status as ordered.

Back 11

Rationale: This promotes wound healing.

Front 12

5. ID learning needs of pt and family.

Back 12

Rationale: This enhances surgical recovery and allays anxiety by preparing pts for post-op convalescence, discharge plans, and self-care.

Front 13

6. Conduct preoperative teaching re: coughing and deep-breathing exercises w/ splinting.

Back 13

Rationale: Deep-breathing exercises improve lung expansion and volume, help expel anesthetic gases and mucus from the airway, and facilitate the oxygenation of body tissues. Coughing helps remove retained mucus from the respiratory tract. Splinting minimizes pain while couging or moving.

Front 14

6A (coughing and deep-breathing exercises w/ splinting)

Back 14

Assist pt to semi-fowler's position, leaning forward.

Front 15

6B

Back 15

Have pt splint a chest or abominal incision by holding a folded bath blanket or pillow against the incision.

Front 16

6C

Back 16

Tell pt to take a deep breath and hold it for 3 seconds.

Front 17

6D

Back 17

Encourage pt to "hack" out three short coughs after holding breath.

Front 18

6E

Back 18

With mouth open pt should take a quick breath.

Front 19

6F

Back 19

Encouraging pt to cough deeply once or twice and then take another deep breath.

Front 20

7. Conduct preoperative teaching re: respiratory therapy regimens such as incentive spirometry.

Back 20

Rationale: Incentive spirometry improves lung expansion, helps expel anesthetic gases and mucus from the airway, and facilitates oxygenation of body tissues.

Front 21

7A (incentive spirometry)

Back 21

An incentive spirometer helps increase lung volume and promot inflation of the alveoli.

Front 22

7B

Back 22

Assist pt to semi-Fowler's position.

Front 23

7C

Back 23

Setting the volume goal indicator on the spirometer.

Front 24

7D

Back 24

PT will hold the device and place lips around the mouthpiece to creat a seal, then taking a deep breath in.

Front 25

7E

Back 25

The pt can observe progress toward the goal by watching the balls or diaphragm or spirometer elevate or lights go on (depending on equip). Have pt repeat 5-10 times q 1-2 hours.

Front 26

8. Conduct preoperative teaching re: management of pain after surgery.

Back 26

Rationale: Using ordered analgesics to minimize pain helps to prevent postoperative complications.

Front 27

9. Conduct preoperative teaching re: leg exercises.

Back 27

Rationale: Leg exercises promote venous return and decrease complications related to venous stasis.

Front 28

9A Leg Exercises

Back 28

Assist to semi-Fowler's position.

Front 29

9B

Back 29

Raise pts right foot and keep it elevated for a few seconds.

Front 30

9C

Back 30

Extend lower portion of leg.

Front 31

9D

Back 31

Lower the entire leg to the bed. This exercise is repeated five times w/ each leg.

Front 32

9E

Back 32

Pt points toes of both feet toward the foot of the bed w/ both legs extended.

Front 33

9F

Back 33

Pt pulls toes toward chin on both feet.

Front 34

9G

Back 34

Pt makes circles w/ both ankles, first one way and then the other.

Front 35

10. Provide preoperative teaching re: early ambulation and turning in bed.

Back 35

Rationale: Turning and moving in bed helps to minimize pain and prevent postoperative complications.

Front 36

10A

Back 36

Instruct the pt to raise one knee and reach across to grasp the siderail on the side of the bed toward which he/she will be turning.

Front 37

10B

Back 37

Help pt to roll over while he/she pushed w/ leg bent and pulls on the side rail.

Front 38

10C

Back 38

Showing pt how to use small pillow to splint a ches or abdominal incision while turning.

Front 39

10D

Back 39

After pt is turned, provide support w/ pillows behind the pts back.

Front 40

13. Document

Back 40

Document what actions were taken.

Front 41

14. Provide emotional support. Answer questions realistically. Provide spiritual assistance if requested. Include family when possible.

Back 41

Rationale: This allays family and patient misconceptions and fears.

Front 42

15. Follow preoperative fluid and food restrictions.

Back 42

Rationale: This reduces risk for vomiting and aspiration during surgery. Anesthetic agents temporarily depress GI function and processes.

Front 43

16. Prepare for elimination needs during and after surgery.

Back 43

Rationale: Anesthetic agents and abd. surgery interfere w/ normal elimination function. A urinary catheter inserted preoperatively minimizes risk for inadvertent trauma to bladder during surgery.

Front 44

17. Attend to pts special hygiene needs.

Back 44

Rationale: This decreases risk for infection.

Front 45

18. Provide for adequate rest.

Back 45

Rationale: Rest minimizes stress before surgery.

Front 46

19. Day of surgery: Check that proper id band is on pt.

Back 46

Rationale: Double-checking ensures id of pt.

Front 47

20. Check consent forms.

Back 47

Rationale: Legally required.

Front 48

21. Check vitals.

Back 48

Rationale: Provides baseline data for comparison.

Front 49

22. Hygiene and oral care.

Back 49

Rationale: Promotes comfort and prevents intraoperative complications during anesthesia inducion.

Front 50

23. Continue nutritional and hydration prep.

Back 50

Rationale: This prepares pt for operative procedure.

Front 51

24. Remove accessories from client. (ie., cosmetics, jewelry, nail polish, dentures...)

Back 51

Rationale: These interfere w/ assessment during surgery.

Front 52

25. Place values in an appropriate area.

Back 52

Rationale: This ensures safety of valuables and personal possessions.

Front 53

26. Have pt empty bladder and bowel before surgery.

Back 53

Rationale: Minimizes the risk for injury or complications after surgery.

Front 54

27. Attend to any preoperative orders.

Back 54

Rationale: This prepares the pt for operative procedures.

Front 55

28. Complete preoperative checklist and record of pts pre-op prep.

Back 55

Rationale: This ensures accurate documentation and communication w/ perioperative nurse caring for pt.

Front 56

29. Administer preoperative meds as prescribed by physician/anesthesia provider.

Back 56

Rationale: Meds reduce anxiety, provides sedation, and diminishes salivary and bronchial secretions.

Front 57

30. Raise side rails, place bed in lowest position. Instruct pt to remain in bed or on stretcher.

Back 57

Rationale: Ensures safety of pt.

Front 58

31. Move pt from bed to transport stretcher if necessary. Reconfirm pt id and document.

Back 58

Rationale: Helping pt to move prevents injury. Reconfirming ensures correct pt.

Front 59

24. Prepare room for pts return.

Back 59

Rationale: Promotes efficient care in the post-op period.